Date of Award

January 2025

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Virginia Pitzer

Second Advisor

Daniel Weinberger

Abstract

ABSTRACTIntroduction: Respiratory syncytial virus (RSV) is a common respiratory pathogen that causes a large burden of disease among older adults. Though there are interventions, the impact and cost-effectiveness of recently licensed RSV vaccines in the United States is not well understood for this population. Thus, reliable estimates on the economic burden of RSV among older adults are needed for future economic analyses.

Objective: The objective of this thesis is to evaluate the cost of medically attended RSV among older adults in the United States.

Methods: Medicare claims data were used to determine average cost per visit for outpatient, inpatient, emergency department, and intensive care unit treatment through retrospective analyses. For outpatient treatment, average costs overall and costs by risk category (high-risk or non-high-risk) were reported. For inpatient, emergency department (ED), and intensive care unit (ICU) treatment, costs per visit were reported overall, by older adult age groups (60-64, 65-69, 70-74, 75-79, 80-84, ≥85), by risk category, and by clinical outcome (death or discharge).

Results: From the healthcare provider perspective, the median (interquartile range) direct costs of outpatient, inpatient, ED, and ICU visits among older adults were $433 ($183-$1,512), $45,258 ($25,249-$85,271), $47,507 ($28,296-$85,335), and $79,538 ($45,930-$145,910), respectively. Additionally, age-specific costs for inpatient, ED, and ICU visits decreased with increasing age group. High-risk older adults had greater average costs per visit (~1.5-3x) than non-high-risk patients in all treatment settings. For inpatient, ED, and ICU treatment settings, the average cost was higher among patients who died compared to patients who were discharged.

Conclusion: This study provides comprehensive information on the economic burden of medically attended RSV among older adults. We generally observed greater costs per visit across all treatment types than in previous studies. This study’s subgroup-specific estimates will be valuable in informing future cost-effectiveness analyses of recently licensed RSV vaccines for older adults.

Comments

This is an Open Access Thesis.

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